ANti-infective Stewardship using the Wisca tool in the Electronic medical Record (The ANSWER study) Beginning in the mid-to late 1980s and accelerating through the 1990s and 2000s the shield of antibiotic invincibility began to crack sufficiently so tat it was apparent to everyone we faced a serious problem. Resistance began to be reported in Gram-negative bacteria toward the newer cephalosporin, fluoroquinolone, and even the carbapenem drugs. During this same period we also witnessed the emergence and spread of a new healthcare associated infection called Clostridium difficile associated diarrhea as well as MRSA becoming pandemic. We now face a healthcare setting where as many as 70% of the bacterial infections afflicting our patients are resistant to at least one antimicrobial that was initially active againt their historical ancestors. Our objectives will be in the main area that describes our focus for this application, which is Antimicrobial Stewardship: Preventing the development and spread of resistant organisms in the healthcare setting. There are two specific aims for this research program to accomplish. They are: 1) Specific Aim 1: Complete development of the personalized weighted-incidence, syndromic, combination antibiogram (WISCA) tool and validate its performance as a comprehensive strategy to improve the treatment of infectious diseases for all hospitalized patiens. - We will demonstrate and expand the use of information technology based on the WISCA for the widespread use of automated clinician prompts enhancing empiric antibiotic therapy as part of a comprehensive infection control stewardship program that reduces antibiotic resistance. 2) Specifi Aim 2: Demonstrate that use of such a tool improves outcome, lowers antimicrobial resistance and reduces cost. - The clinical and economic outcome measures will include changes in length of stay, duration of treatment, use of therapeutic drug monitoring, inpatient mortality, adverse events fro antibacterial therapy, admission and discharge location (with the goal being fewer persons needing skilled care after discharge than is now required), 30 day readmission rates, unintended consequences from antimicrobial agent use, such as Clostridium difficile infection, antimicrobial rug cost and antimicrobial susceptibility. All our faculty are well aware of current developments in thir respective fields and are actively involved in cutting edge research that will be applied in a comprehensive, integrated fashion to solve the problem of antimicrobial resistant HAIs. We look forward to working on this Large Research Project with the Agency for Healthcare Research and Quality (AHRQ) in its mission to improve the quality, safety, efficiency, and effectiveness of healh care for all Americans.